Provider Demographics
NPI:1609165281
Name:JONES, KELLI J (APRN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:J
Last Name:JONES
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 CASTLEROCK RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1737
Mailing Address - Country:US
Mailing Address - Phone:918-510-3577
Mailing Address - Fax:
Practice Address - Street 1:1201 MAGNOLIA CT STE 101
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-1433
Practice Address - Country:US
Practice Address - Phone:405-857-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAPN78832363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200327660AMedicaid